Primary Care Coding Alert

Reviewed on May 22, 2015 The difference between pure tone hearing tests and threshold hearing tests can confound coders. When do you use 92551 (Screening test, pure tone, air only) versus 92552 (Pure tone audiometry [threshold]; air only)? Tip: Keep in mind that one is a screening test and one is a diagnostic test. 
 
Technical Details Point the Way  
Knowing the technical differences and details of each hearing test will help coders choose the appropriate code.  The screening test is basically pass-fail, says Susan Beam, MA, CCC/A, an audiologist at Genesis Healthcare System in Zanesville, Ohio. During the test, a hearing screening device or audiometer produces a series of tones. The patient says whether he or she hears each tone. If the patient fails to hear one or more than one tone (depending on the office criteria for passing), he or she fails the test. At this point, the family physician (FP) will either schedule a threshold test or refer the patient to an audiologist to determine the exact problem. 
 
The threshold test is used to define the more specific diagnosis of the patient’s hearing problem, as opposed to the screening, which determines whether the patient has a hearing problem. Threshold testing identifies the softest level the patient can hear, Beam says. During the threshold test, the patient is presented with a series of tones at varying intensity (loudness). If the patient can hear the tone, the intensity is dropped in 10-decibel (dB) increments until he or she can no longer hear it. Next, the intensity is raised in 5-dB increments until the patient hears the tone again, then gradually dropped again, bracketing the threshold. 
 
The physician records results of the threshold test in an audiogram, a graph charting the levels the patient can hear. Coders can differentiate between the two tests by looking at the audiogram. The threshold will show a variation of different intensity levels recorded on the audiogram, Beam says. In contrast, results for the screening test will appear as just one level on the audiogram. Some physicians do not record screening results on the graph, but instead write in the chart screening.
Criteria for the Tests  
Our doctor will conduct a hearing test on patients who have no signs and symptoms because he may want to fully examine a new patient, or he finds that an established patient has never had a hearing exam, says Pat Thompson, RHIT, coding analyst at Multicare HealthSystems in Tacoma, Wash. When the patient presents without a complaint, that test is a screening. 
 
Medicare does not cover hearing screenings, but some commercial payers do. Coders should report 92551 for the [...]